Category: panic attack

Everyone has experienced intense fear at some point. Our hearts start racing when we realize we forgot to pick up the kids at school, our hands tremble and sweat as we struggle to unlock the door as a dark stranger looms in the shadows, or we feel dizzy and nauseous as we get up to present that speech we haven’t really prepared for. Whether a threat is great or small, the people and things we care about might get hurt if we don’t respond quickly.

We evolved the sympathetic nervous system to prepare us for threat

The physiological response we feel during intense fear and panic is a result of the body’s sympathetic nervous system. The sympathetic nervous system evolved to help us prepare to respond to dangerous situations. Activation of the sympathetic nervous system leads to the kinds of biological changes we experience in fear and panic, including changes in heart rate, blood vessel dilation, breathing, digestion, and perspiration. These changes make us ready to face challenges to our safety through fighting (i.e., overpowering the threat), fleeing (i.e., getting away from the threat), and freezing (i.e., holding your breath and hiding by being still – think about the T-Rex in the movie Jurassic Park). Intense fear (i.e., panic) can be a real life saver, so be glad it’s there for you!

Panic involves an unnecessary but harmless misfiring of the sympathetic nervous system

The biological readiness we call panic mostly evolved to help us deal with immediate threats in the external environment (e.g., being chased by an actual lion), but in humans the same system can also get activated just by vividly imagining threats (e.g., anticipating having a heart attack or going crazy). It’s kind of like going to a scary movie – you can easily forget you’re actually in a nice safe theater and become so engrossed in the movie that you end up being afraid. When we get so caught up in our heads, it can start to feel (i.e., in our body) very much like we are in danger, when in fact we are safe. Even if there are “real dangers” in the distant future, such as dying of old age, actively anticipating them without a sense of perspective can make our bodies respond as if there were imminent danger right here and right now. This is where worry and anxiety come from – imagined threats. Nonhuman animals don’t worry and get anxious about things that aren’t actually happing right here and now – but people do. This ability to imagine future possibilitiess, plan for them, and feel emotions about them is an important part of what makes us human, but it also has this dark side.

In panic, people misinterpret normal bodily signs of anxiety as threatening

People who have recurrent and repeated problems with attacks of panic (sometimes called panic disorder) experience their bodily sensations of anxiety and fear as if there were an imminent threat happening here and now. That is, their minds accidentally interpret fear itself as a being a threat. A classic example is when someone interprets an elevated heart rate as evidence of a heart attack, and then takes this interpretation too seriously. The vividly imagined threat of a heart attack activates the sympathetic nervous system, which then further elevates the heart rate, which then provides more “evidence” of a heart attack, and so forth until the person is totally convinced that he or she is going to die. Feedback loops like this can lead to a major meltdown. A “panic attack” is just that – a catastrophic interpretation of otherwise harmless bodily sensations, leading to more and more fear and panic. The problem lies with how the sensations of fear and panic are interpreted, not with the sensations themselves.

The solution to panic attacks

Stop running and instead, feel the fear. Get warm and cozy with it. After all, panic is your good buddy who is trying to keep you safe, not an enemy looking to harm you. A friendly relationship with panic can be very counterintuitive at first – after all, panic doesn’t feel safe. You may be tempted to try to get rid of it with medications (fighting), or to try to stay away from situations in which you might panic (fleeing), or maybe if you just hunker down and wait it out it won’t happen again (freezing). See the problem here? That is all more panic! You can’t fight fire with more fire, but the good news is you don’t need to in the first place. If instead you learn to “hang out” with panic, you can learn that it is in fact perfectly safe despite how it feels.

This can of course be a fairly difficult thing to learn; a “just do it” approach to accepting panic sensations is often not helpful. Fortunately, you can find guidance in learning how to be less reactive to your own thoughts and feelings – a mindfulness practice is a great way to help gain perspective, and there are good self-help books out there that can be helpful. Furthermore, there are evidence-based psychotherapies that have been proven to help people with panic disorder – give me a call if you’d like to schedule an initial consultation.

If there is a real threat out there in the world – attack it, run from it, or hide! But your own sympathetic nervous system is not your enemy. You are safe with yourself.

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